Case 4:20-cv-00020-MW-CAS Document 1 Filed 01/13/20 Page 1 of 53

UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF FLORIDA
TALLAHASSEE DIVISION

JAMI CLAIRE and KATHRYN LANE,
Plaintiffs,
Case No.: 4:20-cv-20

v.
FLORIDA DEPARTMENT OF
MANAGEMENT SERVICES; JONATHAN
SATTER, in his official capacity as
Secretary of the Florida Department of
Management Services; UNIVERSITY OF
FLORIDA BOARD OF TRUSTEES;
MORTEZA HOSSEINI, in his official
capacity as Chair of the University of
Florida Board of Trustees; THOMAS
KUNTZ, DAVID BRANDON, JAMES
HEAVENER, LEONARD JOHNSON,
MICHAEL MURPHY, DANIEL O’KEEFE,
RAHUL PATEL, MARSHA POWERS,
JASON ROSENBERG, ROBERT STERN,
RAY THOMAS, and ANITA ZUCKER, in
their official capacities as Members of the
University of Florida Board of Trustees;
and ANDY THOMAS, in his official
capacity as Public Defender of the Second
Judicial Circuit of Florida,
Defendants.

COMPLAINT FOR DECLARATORY
AND INJUNCTIVE RELIEF AND DAMAGES

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PRELIMINARY STATEMENT
1.

Plaintiffs Jami Claire (“Ms. Claire”) and Kathryn Lane (“Ms.

Lane”) are employees of the State of Florida (“State”). As part of their
compensation for employment, they receive employer-sponsored health
insurance benefits that are solicited, chosen, and implemented by the
State (“State Plans”). All of the State Plans, including those provided to
Plaintiffs, explicitly exclude coverage of “gender reassignment or
modification services or supplies” (“State Plan Exclusion”). Plaintiffs are
transgender individuals who were, and who continue to be, denied
coverage for medically necessary gender-affirming care (also referred to
as “transition-related care”) for gender dysphoria due to this categorical
exclusion.
2.

Gender-affirming care is medically necessary treatment for

gender dysphoria, a medical condition codified in the Diagnostic and
Statistical Manual of Mental Disorders (“DSM-5”) and the International
Classification of Diseases (“ICD-10”). The State Plan Exclusion
contravenes the well-established medical consensus that such treatment
can be medically necessary and life-saving.
3.

As a result of the State Plan Exclusion, Plaintiffs have been

forced to forego medically necessary care for gender dysphoria. The
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State Plans single out transgender employees, like Plaintiffs, for unequal
treatment by categorically depriving them of coverage for genderaffirming care through the State Plan Exclusion. Other State employees
who are not transgender do not face categorical exclusions barring
coverage for medically necessary health care.
4.

The State’s categorical exclusion of medically necessary gender-

affirming care in all State Plans constitutes unlawful sex discrimination in
violation of Title VII and the Equal Protection Clause. Plaintiffs bring this
action for declaratory and injunctive relief and damages pursuant to 42
U.S.C. § 2000e and 42 U.S.C. § 1983, for past and ongoing injury to their
rights.
JURISDICTION
5.

This action arises under 42 U.S.C. § 1983 and Title VII, 42 U.S.C.

§ 2000e.
6.

This Court has jurisdiction over Plaintiffs’ claims pursuant to 42

U.S.C. § 2000e-5(f)(3) (Title VII); 28 U.S.C. § 1331 (federal question); 28
U.S.C. § 1343(a)(3), & (4) (civil rights); and 28 U.S.C. §§ 2201 & 2202
(declaratory judgment).

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VENUE
7.

Venue is proper in the Northern District of Florida under 42

U.S.C. § 2000e-5(f)(3) and 28 U.S.C. § 1391(b). Plaintiffs reside,
Defendants reside, and all of the acts or omissions complained of herein
occurred and will continue to occur in the Northern District of Florida.
Venue is proper in the Tallahassee Division of the Northern District of
Florida under N.D. Fla. Loc. R. 3.3 because it is where at least three of
the Defendants and one of the Plaintiffs reside and where a substantial
portion of the acts or omissions complained of herein occurred.
PLAINTIFFS
8.

Ms. Claire resides in Trenton, Florida. She is a 62-year-old

transgender woman. For 32 years, Ms. Claire has been a dedicated
employee of the University of Florida, a component of the State’s
government. She works as a Senior Biological Scientist in the College of
Veterinary Medicine. At all relevant times, Ms. Claire has been an
employee of the University of Florida. The University of Florida’s
employees are State employees. As a State employee, Ms. Claire
receives an employer-sponsored health plan through the State as part of
the “compensation, terms, conditions, or privileges of employment.” 42
U.S.C. § 2000e-2(a)(1).
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9.

Ms. Lane resides in Tallahassee, Florida. She is a 39-year-old

transgender woman. Ms. Lane is a licensed attorney, working within the
appellate division of the Office of the Public Defender in the Second
Judicial Circuit of Florida in Tallahassee, a component of the State’s
government. At all relevant times, Ms. Lane was an employee of the Office
of the Public Defender. The Office of the Public Defender’s employees
are State employees. As a State employee, Ms. Lane receives an
employer-sponsored health plan through the State as part of the
“compensation, terms, conditions, or privileges of employment.” 42 U.S.C.
§ 2000e-2(a)(1).
DEFENDANTS
10.

Ms. Claire and Ms. Lane sue defendant Florida Department of

Management Services (“Department”), an agency of the State’s
government. The Division of State Group Insurance is within the
Department of Management Services. The Department creates the
requirements for the State Plans offered to State employees and is an
employer within the meaning of Title VII. The Department determines
components of State employees’ specific “compensation, terms,
conditions, or privileges of employment[,]” 42 U.S.C. § 2000e-2(a)(1),

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when it establishes the scope of health insurance coverage for State
employees.
11.

Ms. Claire and Ms. Lane sue defendant Jonathan Satter in his

official capacity as Secretary of the Florida Department of Management
Services, an agency of the State’s government. As Secretary, Satter is
the head of the Department. § 20.22, Fla. Stat. (2019).
12.

Ms. Claire sues defendant University of Florida Board of

Trustees (“Board of Trustees”). The Board of Trustees governs and
oversees the operations of the University of Florida and is an employer
within the meaning of Title VII. The University of Florida is a public
university in the State university system. The Board of Trustees is a
corporate body with the ability to sue and be sued. § 1001.72, Fla. Stat.
(2019). The Board of Trustees’ established powers and duties include
controlling certain terms and conditions of employment for the University’s
employees. For example, it sets compensation and employee benefits,
which include providing healthcare coverage to University of Florida
employees – including Ms. Claire – through State Plans solicited, chosen,
and implemented by the Department.
13.

Ms. Claire sues defendant Moretza Hosseini, in his official

capacity as Chair of the Board of Trustees, and defendants Thomas
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Kuntz, David Brandon, James Heavener, Leonard Johnson, Michael
Murphy, Daniel O’Keefe, Rahul Patel, Marsha Powers, Jason Rosenberg,
Robert Stern, Ray Thomas, Anita Zucker, in their official capacities as
Board of Trustees members. As Board of Trustees members, they carry
out all lawful functions permitted by the Board’s Bylaws, its Operating
Procedures, Board of Governors regulations, or other law. These
functions include setting compensation and other conditions of
employment, including benefits. Board of Governors Regulation 1.001.
14.

Ms. Lane sues defendant Andy Thomas in his official capacity as

Public Defender of the Second Judicial Circuit of Florida. Defendant
Thomas controls certain terms and conditions of Ms. Lane’s employment
and is an employer within the meaning of Title VII.
15.

At all times relevant to this Complaint, defendants acted under

color of state law and knew, or should have known, of the policies,
practices, acts, or omissions alleged herein.
FACTUAL ALLEGATIONS
Transgender individuals and Gender Dysphoria
16.

“Sex assigned at birth” refers to the concept that in our society,

sex is typically assigned at birth based on the appearance of external
genitalia.
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17.

“Gender identity” is a well-established medical concept referring

to one’s sense of belonging to a particular gender. Typically, people who
are designated female at birth based on their external anatomy identify as
girls or women, and people who are designated male at birth identify as
boys or men. For transgender individuals, however, the sense of one’s
self—one’s gender identity—differs from the sex assigned to them at birth.
18.

All human beings have a gender identity.

19.

“Gender expression” is the outward manifestation of one’s

gender identity.
20.

“Transgender” is an umbrella term for persons whose gender

identity or gender expression does not conform to that typically associated
with the sex to which they were assigned at birth.
21.

Transgender men are men who were assigned “female” at birth

but have a male gender identity. Transgender women are women who
were assigned “male” at birth but have a female gender identity.
22.

The medical diagnosis for the feeling of incongruence between

one’s gender identity and one’s sex assigned at birth, and the resulting
distress caused by that incongruence, is called “gender dysphoria.”
Gender dysphoria is a medical condition codified in the DSM-5 (§ 302.85)
and the ICD-10.
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23.

Gender dysphoria is a serious, but treatable, medical condition.

Left untreated, it can lead to debilitating distress, depression, anxiety,
impairment of function, substance use, self-surgery to alter one’s genitals
or secondary sex characteristics, self-injurious behavior, and even
suicide.
24.

The American Medical Association, the American Psychiatric

Association, the American Psychological Association, the American
Counseling Association, the American Psychoanalytic Association, the
American Academy of Child and Adolescent Psychiatry, the American
Academy of Nursing, the American Academy of Pediatrics, the World
Professional Association of Transgender Health, and many other leading
medical organizations recognize the medical necessity of genderaffirming care for transgender people with gender dysphoria.
25.

The World Professional Association for Transgender Health

(“WPATH”) publishes the widely accepted standards of care for treating
gender dysphoria. The WPATH Standards of Care have been recognized
as authoritative standards of care by the leading medical organizations,
the U.S. Department of Health and Human Services, and several federal
courts.

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26.

Under the WPATH standards, medically necessary treatment for

gender dysphoria can include numerous steps to affirm one’s gender
identity and help an individual alleviate dysphoria by establishing physical,
phenotypic, social, and expressive congruence with the transgender
individual’s gender identity. This treatment, often referred to as genderaffirming care, may include social transition (living and presenting oneself
to the world in accordance with one’s gender identity), counseling,
hormone replacement therapy, and surgery (sometimes called genderaffirming surgery, gender-confirming surgery, sex-reassignment surgery,
or gender corrective surgery).
27.

Gender-affirming surgery includes any surgical procedure to

alter or adjust an individual’s primary or secondary sex characteristics to
align with their gender identity.
28.

Not all transgender individuals will need these medical

interventions. Some transgender people may not experience gender
dysphoria. But for other individuals, these are medically necessary
procedures.
29.

When individuals diagnosed with gender dysphoria do not obtain

competent

and

necessary

treatment,

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serious

and

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psychological distress can occur, including depression, anxiety, selfharm, and suicidal ideation.
30.

Under the WPATH standards, treatment is based on the

individualized needs of the person. Under each patient’s treatment plan,
the goal is to enable the individual to live all aspects of one’s life consistent
with their gender identity, thereby eliminating the distress associated with
the incongruence.
31.

According to every major medical organization and the

overwhelming consensus among medical experts, treatments for gender
dysphoria, including surgical procedures, are effective, safe, and
medically necessary for many transgender persons to alleviate their
gender dysphoria.
32.

WPATH standards recognize that treatment for gender

dysphoria is multimodal. Some transgender persons diagnosed with
gender dysphoria require hormones, some may need to accord their
expression and presentation with their gender, some may need surgical
intervention, and some may need a combination of treatments.
33.

In the past, public and private insurance companies excluded

coverage for gender-affirming care based on the misunderstanding that
such treatments were cosmetic or experimental. Today, gender-affirming
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care, including surgical care, is routinely covered by private insurance
programs and the majority of Fortune 500 companies. More than 20 states
explicitly cover gender-affirming care in their Medicaid plans, and 19
states and the District of Columbia prohibit the exclusion of genderaffirming care in private insurance policies.
34.

The American Medical Association, American Psychological

Association, American Psychiatric Association, American College of
Obstetricians and Gynecologists, and other leading medical organizations
have issued policy statements and guidelines supporting healthcare
coverage for gender-affirming care as medically necessary under
contemporary standards of care.
35.

No major medical organization has taken the position that

gender-affirming care cannot be medically necessary, nor has any such
group supported bans on insurance coverage for gender-affirming care.
The State Plans
36.

The State of Florida offers health-insurance benefits to State

employees and their dependents through the State Plans (“State Plans”).
37.

By statute, the Department is responsible for purchasing health

care for State employees under the State Plans, including developing
requests for proposals or invitations to negotiate for State employee
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health services, determining the provided healthcare benefits, and
negotiating contracts for healthcare and healthcare administrative
services. § 110.123(3)(c), Fla. Stat. (2019).
38.

Through the Department, the State contracts with private health

maintenance organizations to provide employees with health care under
the State Plans through the Department’s procurement process.
39.

Aetna, AvMed, Capital Health Plan, and UnitedHealthCare

solicited and were awarded contracts by the Department. These insurers
administer the State Plans.
40.

The Department awarded contracts to AvMed for Gilchrist

County, which is where Ms. Claire resides, and to Capital Health Plan for
Leon County, which is where Ms. Lane resides.
41.

As part of compensation for employment, the University of

Florida Board of Trustees provides Ms. Claire with health care coverage
through the State Plans selected by the Department and administered by
AvMed.
42.

Although the Board of Trustees offers certain categories of

employees at the University of Florida additional health care plan options,
the Board of Trustees only offers the State Plans to some employees,
including Ms. Claire.
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43.

The Office of the Public Defender only offers its employees,

including Ms. Lane, health care coverage through the State Plans.
The State Plans’ Exclusion of Gender-Affirming Care
44.

On October 11, 2016, the Department issued an Invitation to

Negotiate, soliciting private health maintenance organizations to offer 3year contracts to administer State Plans (“Invitation to Negotiate”).
45.

The Invitation to Negotiate established the defined scope of

benefits to be offered under the State Plans and provided a categorical
exclusion for “gender reassignment or modification services and supplies”
(“State Plan Exclusion”).
46.

Private health maintenance organizations were required to agree

to administer the State Plans as outlined by the Department in the
Invitation to Negotiate, including agreeing to the State Plan Exclusion.
47.

The Department retains the authority to modify the scope of

benefits at any time.
48.

On April 18, 2017, the Department published a Notice of Intent

to Award contracts with health maintenance organizations to administer
the State Plans. Contracts were awarded to Aetna, AvMed, Capital Health
Plan, and United Health Care.

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49.

The Department intentionally solicited State Plans with

categorical exclusions for medically necessary gender-affirming care.
50.

All of the State Plans solicited, chosen, and implemented by the

Department for all State employees, including Plaintiffs, explicitly exclude
coverage of “gender reassignment or modification services or supplies.”
51.

State employees covered by State Plans receive health

insurance coverage for other medically necessary care.
52.

Transgender individuals covered by State Plans do not receive

health insurance coverage for gender-affirming care, although it is
medically necessary, due to the State Plan Exclusion.
53.

The State establishes the terms, conditions, and criteria used in

the determination of whether services are medically necessary.
54.

The State’s definition of “medical necessity” for administration of

State Plans, as provided in AvMed and CapitalHelath coverage booklets,
is:
The use of any appropriate medical treatment, service,
equipment and/or supply as provided by a Hospital, skilled
nursing facility, physician or other provider which is
necessary for the diagnosis, care and/or treatment of a
Health Plan Member’s illness or injury, and which is:
1) Consistent with the symptom, diagnosis, and
treatment of the Health Plan Member’s condition;
2) The most appropriate level of supply and/or service
for the diagnosis and treatment of the Health Plan
Member’s condition;
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3) In accordance with standards of acceptable
community practice;
4) Not primarily intended for the personal comfort or
convenience of the Health Plan Member, the Health
Plan Member’s family, the physician or other health
care providers;
5) Approved by the appropriate medical body or health
care specialty involved as effective, appropriate and
essential for the care and treatment of the Health Plan
Member’s condition; and
6) Not Experimental or Investigational.

55.

In the State Plans procured by the Department, an exclusion

exists for any services considered to be “Experimental/Investigational or
Not Medically Necessary Treatment.”
56.

Given there is already an exclusion for any services considered

to be “Experimental/Investigational or Not

Medically Necessary

Treatment,” the only function of the categorical State Plan Exclusion for
gender-affirming care is to exclude medical care that would otherwise
qualify as medically necessary under the State Plans’ generally applicable
standards.
57.

The State Plan Exclusion is a categorical exclusion that

precludes transgender state employees from having their genderaffirming medical needs subjected to the same medical necessity analysis
to which all other state plan members’ medical needs are subjected.

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58.

The State Plan Exclusion was specifically included in the State

Employees’ HMO Plan Group Health Insurance Plan Booklet & Benefits
Document provided to each Plaintiff by their employer.
59.

The medical procedures Plaintiffs seek, which the State

continues to deny, are medically necessary for them. Despite meeting the
medical-necessity criteria for gender-affirming treatment for gender
dysphoria, the State Plan Exclusion wrongfully denied, and continues to
deny, coverage to each Plaintiff.
The State’s Denial of Medically Necessary Care to Plaintiffs
Plaintiff Jami Claire
60.

Ms. Claire is a Senior Biological Scientist in the College of

Veterinary Medicine at the University of Florida, where she has been
employed for thirty-two years.
61.

Ms. Claire served in the United States Navy from 1974-1980.

She served for six and one-half years, first as a cook, and then as an
aircraft electrician.
62.

Ms. Claire received her B.S. in Animal Science Production from

Brigham Young University in 1984 and her M.S. in Animal Science
Management from Utah State University in 1989.

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63.

Ms. Claire is a woman. She is also transgender. She was

assigned a male birth sex, but her gender identity is female and she
identifies as a woman.
64.

Ms. Claire has a well-established social and professional identity

as a woman. She has experienced gender dysphoria since the age of
seven.
65.

It was not until 1975, when Ms. Claire was seventeen years old,

that she finally discovered a name for what she had felt all her life. She
was enlisted in the United States Navy and was eating a meal with her
fellow sailors when she first heard celebrity Renée Richards discussing
her experience affirming her female gender identity despite being
assigned the male sex at birth. In that moment, Ms. Claire realized she
was transgender.
Gender-Affirmation History
66.

Ms. Claire began her gender-affirmation in 1997, during which

time she was diagnosed with gender dysphoria, and began going to
counseling for her dysphoria, taking hormones, and undergoing
electrolysis (hair removal).
67.

At that time, Ms. Claire inquired into whether her State Plan

would cover her gender-affirming care and was told it would not. Ms.
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Claire then paid out of pocket for her treatment, including hormones. Her
counseling was covered by the Veterans Affairs Medical Center. She
continued her gender-affirmation, through counseling, hormones, and
electrolysis, for five years.
68.

Despite her strong desire to continue to bring her body into

alignment with her female gender identity, Ms. Claire was forced to cease
her gender-affirmation around 2002. Ms. Claire’s wife and children
wanted nothing to do with her because of Ms. Claire’s gender identity. Her
family disowned her, and she knew the Mormon Church would excommunicate her if she continued gender-affirmation. Additionally, she
could not afford the gender-affirming care she had been paying for out of
pocket due to the financial toll of her divorce.
69.

Fourteen years later, in 2016, Ms. Claire resumed her gender-

affirmation to live authentically as a woman. Resuming Ms. Claire’s
gender-affirming care remained medically necessary for her due to the
constant stress, anxiety, pain, and anguish she experienced struggling to
live her life as a man.
70.

Ms. Claire meets the DSM-5 criteria for the diagnosis of Gender

Dysphoria, 302.85, as well as the ICD-10 criteria for the diagnosis of
Gender Identity Disorder, F64.0.
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71.

Ms. Claire always had a strong desire to outwardly express her

female gender identity and to align her body with her female gender
identity. However, Ms. Claire feared the consequences of doing so in her
personal and professional life, due to the stigma and political violence
transgender people in our society often face.
72.

In the summer of 2016, Ms. Claire again began counseling with

the transgender care coordinator at the Department of Veterans Affairs
Medical Center (“VA”) in Gainesville, where she received primary care for
over twelve years. She consistently has been in counseling since that time
for her gender dysphoria.
73.

In December 2016, Ms. Claire began outwardly expressing her

female gender identity in all public spaces, both in her personal life and
her professional life as an employee of the University of Florida College
of Veterinary Medicine. She has done so consistently ever since.
74.

Ms. Claire sought to resume hormone replacement therapy,

intending to induce physical changes in the body caused by female
hormones during puberty, to feminize her body, and to have her hormone
levels match her gender identity.

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75.

A mental health professional evaluated Ms. Claire to determine

her readiness for hormones, and she was referred to an endocrinologist
for hormone replacement therapy.
76.

In May 2017, Ms. Claire began hormone replacement therapy at

the recommendation of her therapist and her treating endocrinologist, as
recommended by the WPATH Standards of Care. Ms. Claire inquired
about coverage by her State Plan but was told her State Plan refused to
cover hormone replacement therapy due to the State Plan Exclusion.
77.

In 2017, Ms. Claire also began electrolysis, to help treat the

dysphoria she experienced as a result of having body hair not typical of a
female. As indicated by the WPATH Standards of Care, electrolysis can
be a medically necessary treatment to alleviate gender dysphoria. Again,
Ms. Claire inquired about coverage by her State Plan, but was told that
her State Plan refused to cover this treatment due to the State Plan
Exclusion.
78.

Ms. Claire paid out of pocket for the electrolysis treatments until

August 2018.
79.

To ensure her legal identity matched her female gender identity

and expression, Ms. Claire obtained a court order from Florida’s Eighth

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Judicial Circuit Court on September 1, 2017, officially changing her legal
name to Jami Lynn Claire.
80.

Ms. Claire subsequently amended the legal name and gender

marker on her government-issued identification documents to reflect her
female gender identity, including her Social Security record, Florida
driver’s license, U.S. Passport, and DD-214 (Certificate of Release or
Discharge from Active Duty).
81.

In November 2018, Ms. Claire underwent an augmentation

mammoplasty to continue feminizing her body. The WPATH Standards of
Care recognize augmentation mammoplasty is medically necessary for
some transgender individuals. Again, Ms. Claire inquired about coverage
by her State Plan, but was told that her State Plan refused to cover this
treatment due to the State Plan Exclusion. Therefore, she paid out of
pocket for the surgery.
Medical Necessity of Denied Procedure
82.

Ms. Claire has received hormone replacement therapy for over

two years. She is on the anti-androgen (testosterone blocker)
spironolactone and estrogen.
83.

The goal of hormone replacement therapy for transgender

women is to induce physical changes in the body caused by female
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hormones during puberty (secondary sex characteristics) to promote the
matching of an individual’s gender identity and body (gender
congruence). This requires a suppression of endogenous androgens
(testosterone) and the addition of estrogen.
84.

Long term use of estrogen comes with risks, including liver

disease, cardiovascular disease, metabolic syndrome, and breast cancer.
One of the most common and concerning risks is that estrogen increases
the risk of blood clots. Blood clots can cause death, permanent lung
damage, permanent brain damage (stroke), heart attack, or chronic
problems with the veins in the legs.
85.

Transdermal estrogen (absorbed by skin through patches) has

been shown to decrease the risk of blood clots. For this reason,
transdermal estrogen is usually recommended to anyone over the age of
forty.
86.

Ms. Claire, however, must ingest the estrogen orally through pills

because her body cannot absorb the estrogen through transdermal
patches; and, due to her age, she is ineligible for estrogen injections.
87.

Ms. Claire is sixty-two years old, and is at a heightened risk of

developing deep vein thrombosis. Deep vein thrombosis is a blood clot
that forms in a vein deep in the body, most often in the lower leg or thigh.
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A deep vein thrombosis can break loose and cause a pulmonary
embolism in the lung. This is a constant source of concern for Ms. Claire.
88.

The testicles are the main source of testosterone production.

When hormone replacement therapy fails to block the production of
testosterone and change hormonal levels in the body, surgical removal of
the testicles functions to remove the main source of testosterone
production and its effects. This allows patients to cease or significantly
reduce their dosage of androgen-blockers (spironolactone) and to reduce
their dosage of estrogen.
89.

Due to the potential health risks and long-term effects of

continuing such high dosages of hormones at her age, Ms. Claire sought
an orchiectomy (surgical removal of the testicles), a procedure that the
WPATH Standards of Care recognize can be medically necessary and
was recommended by her treating physician in accordance with those
standards.
90.

Ms. Claire’s treating physician deemed this procedure medically

necessary to treat her gender dysphoria.
91.

Peer-reviewed medical literature has demonstrated gender-

affirmation surgeries, such as orchiectomies, can ameliorate the

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psychological symptoms of gender dysphoria, including depression,
anxiety, and suicidal ideation.
Procedure Denied by Defendants
92.

On December 27, 2018, Ms. Claire sought authorization through

her State Plan for an orchiectomy.
93.

On January 8, 2019, AvMed denied insurance coverage for the

medically necessary procedure, citing to the State Plan Exclusion of
“gender reassignment or modification services or supplies” as the basis
for denial.
94.

On January 25, 2019, Ms. Claire appealed this denial to AvMed.

95.

On February 22, 2019, AvMed denied the appeal, again citing to

the State Plan Exclusion of “gender reassignment or modification services
or supplies” as the basis for the denial.
96.

On March 18, 2019, Ms. Claire filed a second-level appeal to the

Division of State Group Insurance.
97.

On May 17, 2019, the Division of State Group Insurance denied

the appeal, citing to the State Plan Exclusion of “gender reassignment or
modification services or supplies” as the basis for the denial.
98.

Had the requested surgery been recommended by a medical

provider for a medically necessary purpose other than treatment for
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gender dysphoria – for instance, an orchiectomy for an individual suffering
from testicular cancer or trauma to the testes – the State Plan would have
covered it.
99.

Ms. Claire has suffered, and will continue to suffer, because of

the State Plan Exclusion.
100. Ms. Claire meets all the criteria set forth in the WPATH
Standards of Care concerning the medical necessity for the orchiectomy.
101. Ms. Claire has followed all the recommended WPATH Standards
of Care for gender-affirmation, including mental health counseling,
hormone replacement therapy, and social transition in all spheres of
functioning, and her physician has deemed her ready to undergo the
medically necessary next step of an orchiectomy. Medical research
supports an orchiectomy as a medically necessary intervention for some
transgender

women.

Medical

research

additionally

documents

substantial quality-of-life benefits in emotional, physical, and social
domains for those who have undergone this procedure.
102. The State Plan Exclusion prevents Ms. Claire from obtaining
medically necessary treatment in accordance with her physicians’
recommendations and the WPATH Standards of Care, putting her at a
heightened risk for serious health complications such as blood clots and
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deep vein thrombosis. The State Plan Exclusion also precludes her from
taking the next essential step in her treatment for gender dysphoria.
103. Ms. Claire has suffered as a result of the actions of the Board of
Trustees as well.
104. The Board of Trustees must allow university employees to
participate in State Plans through the State insurance group programs,
but are not limited to providing only those State Plans to employees.
105. By statutory authority, the Board of Trustees creates universitysponsored insurance programs. For example, the Board of Trustees
established GatorCare Health Management Corporation (“GatorCare”) in
2012, through which it offers health benefits to certain classifications of
employees, but not all employees.
106. GatorCare covers gender-affirming surgery and services related
to gender dysphoria or gender-affirmation.
107. Ms. Claire has been offered only the State Plan with the
corresponding State Plan Exclusion for gender-affirming care.
108. The duties of the Board of Trustees include ensuring that the
University complies with federal and State laws and regulations.

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Exhaustion of Administrative Remedies
109. On June 4, 2019, Ms. Claire timely filed a charge with the Equal
Employment Opportunity Commission (“EEOC”) against AvMed, the
Florida Department of Management Services, and the University of
Florida for sex discrimination in violation of Title VII.
110. On July 22, 2019, Ms. Claire requested the Notice of Right to
Sue on all charges.
111. On July 27, 2019, the EEOC issued the Notice of Right to Sue
for all charges.
112. On August 6, 2019, Ms. Claire requested that the Notice of Right
to Sue for the charges against the Florida Department of Management
Services and the University of Florida be issued by the U.S. Department
of Justice, pursuant to 42 USC § 2000e-5(f)(1) and 29 CFR §
1601.28(d)(2).
113. On October 21, 2019, Ms. Claire received the Notice of Right to
Sue letter from the U.S. Department of Justice for the charges against the
Florida Department of Management Services and the University of
Florida.

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Plaintiff Kathryn Lane
114. Ms. Lane is an attorney, currently working within the appellate
division of the Office of the Public Defender in the Second Judicial Circuit
of Florida.
115. Ms. Lane received her B.A. in Political Science from St. Leo
University in 2003 and her J.D. from the University of Florida in 2006.
116. Ms. Lane worked as a prosecutor for the Office of the State
Attorney for the Fifth Judicial Circuit of Florida in Ocala from 2006 to 2011.
117. Ms. Lane worked in the criminal appeals division of the Florida
Attorney General’s office from 2011 to 2017.
118. Ms. Lane is a woman. She is also transgender. She was
assigned a male birth sex, but her gender identity is female and she
identifies as a woman.
119. Ms. Lane has a well-established social and professional identity
as a woman. She has experienced gender dysphoria since approximately
the age of five, but suppressed her female gender identity for as long as
possible until she could no longer do so. This has caused her severe
depression and anxiety.

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Gender-Affirmation History
120. Ms. Lane embraced the female gender with which she has
always identified in 2012, at which time she began her gender-affirmation.
121. Ms. Lane began counseling in March 2012.
122. Ms. Lane meets the DSM-5 criteria for the diagnosis of Gender
Dysphoria, 302.85, as well as the ICD-10 criteria for the diagnosis of
Gender Identity Disorder, F64.0. She was diagnosed with gender
dysphoria in March 2012. Her symptoms are characterized as severe.
123. In Spring 2012, Ms. Lane began the process of facial hair
removal. She inquired about coverage by her State Plan but was told that
her State Plan refused to cover the treatment due to the State Plan
Exclusion. She paid out of pocket for this treatment.
124. In August 2012, Ms. Lane began hormone replacement therapy.
She has been on estrogen and spironolactone for over seven years.
125. In Fall 2012, Ms. Lane began growing out her hair so she would
be identified more easily as a female, which would alleviate some of her
dysphoria.
126. In March 2015, Ms. Lane began outwardly expressing her female
gender identity in all areas of her life.

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127. In

June

2015,

Ms.

Lane

underwent

an

augmentation

mammoplasty to continue the feminization of her body. The WPATH
Standards of Care recognize augmentation mammoplasty is medically
necessary for some transgender individuals. Again, Ms. Lane inquired
about coverage by her State Plan, but she was told that her State Plan
refused to cover this treatment due to the State Plan Exclusion. Therefore,
she paid out of pocket for the surgery.
128. Since 2015, Ms. Lane has presented consistently as female in all
areas of her personal and professional life, including updating her name
with The Florida Bar as part of her professional transition.
129. To ensure that her legal identity matched her female gender
identity and expression, Ms. Lane obtained a court order from Florida’s
Second Judicial Circuit Court on August 27, 2015, officially changing her
legal name to Kathryn Lane to match her female gender identity.
130. Ms. Lane subsequently amended the legal name and gender
marker on her government-issued identification documents to reflect her
female gender identity, including her Social Security record, Florida
driver’s license, and U.S. Passport.

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Procedure Denied by Defendants
131. Ms. Lane has undergone gender-affirming hormone replacement
therapy for seven years, and treating physicians believe she has received
the maximum benefit from this therapy. They expect no further physical
change. Despite hormone therapy, her facial structure remains
phenotypically male. To more fully alleviate her gender dysphoria, she
requires medically necessary surgery.
132. The WPATH Standards of Care recognize that for those who do
not experience relief due to other measures, “surgery is essential and
medically necessary to alleviate their gender dysphoria…relief from
gender dysphoria cannot be achieved without modification of their primary
and/or secondary sex characteristics to establish greater congruence.”
133. Gender-affirming surgeries for the face, known as facial
feminization surgery, can be a critical part of gender-affirmation for a
transgender woman. Facial features play an important part in being
recognized as a particular gender. The public’s ability to recognize an
individual as transgender based on their facial features places that
individual at risk of violence, harassment, and discrimination.
134. Facial feminization surgery facilitates the ability of a transgender
woman in “passing” (i.e., blending or assimilating), which refers to a
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transgender person's ability to go through daily life without being
recognized as being transgender.
135. After a consultation, Ms. Lane’s physician recommended facial
feminization surgery as a medically necessary treatment for her gender
dysphoria. Consistent with the WPATH Standards, Dr. Keojampa
recommended via letter on January 11, 2019, that Ms. Lane obtain the
gender-affirming surgery.
136. On February 19, 2019, Ms. Lane received a denial letter from
Capital Health denying authorization for coverage of the medically
necessary procedure, citing the State Plan Exclusion of “gender
reassignment or modification services or supplies” as the basis for denial.
137. Ms. Lane appealed this denial to Capital Health on April 16,
2019.
138. On April 25, 2019, Capital Health denied the appeal, again citing
the State Plan Exclusion of “gender reassignment or modification services
or supplies” as the basis for denial. Capital Health added as a basis for
denial the exclusion for “Cosmetic Surgeries/Services.”
Procedure Denied by Defendants is Medically Necessary
139. The surgery for which Ms. Lane sought authorization is medically
necessary treatment recommended by professionals specializing in
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gender-affirming care to alleviate the significant depression, anxiety, and
psychological distress that she faces on a daily basis. This procedure is
a medically necessary treatment for Ms. Lane’s gender dysphoria.
140. Despite her intentionally feminine presentation, Ms. Lane’s facial
features can still be identified as masculine, which causes her significant
anxiety, depression, and psychological distress, in addition to putting her
at risk for violence, harassment, and discrimination.
141. Transgender

women

face

violence,

harassment,

and

discrimination at disproportionately high rates, and there are transgender
women murdered in Florida every year because they are transgender.
142. Ms. Lane lives in fear of such interactions as a result of having
facial features that can be identified as masculine and that “out” her (i.e.,
disclose that she is transgender) to strangers without her consent or
volition.
143. Despite Ms. Lane’s consistent participation in psychotherapy
since 2012, various psychotropic regimens and Transcranial Magnetic
Stimulation

(a

noninvasive

procedure

that

uses magnetic

fields

to stimulate nerve cells in the brain to improve symptoms of depression),
she persistently experiences depressed mood, self-esteem deficits,

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disgust and dissatisfaction with her appearance, suicidal ideation, fatigue,
anxiety, fear, and a pervasive sense of hopelessness.
144. Ms. Lane meets all of the criteria set forth in the WPATH
Standards of Care concerning the medical necessity of gender-affirming
surgery.
145. Ms. Lane has followed all the recommended WPATH Standards
of Care for gender-affirmation, including mental health counseling,
hormone replacement therapy, and social transition in all spheres of
functioning, and multiple physicians have deemed her ready to undergo
the medically necessary next step of facial feminization surgery.
146. Medical research supports facial feminization surgery as a
medically necessary intervention for transgender females. This research
documents the substantial quality-of-life benefits in emotional, physical,
and social domains for those who have undergone this procedure.
Procedure Denied by Defendants is Not Cosmetic
147. The WPATH Standards of Care, the U.S. Department of Health
and Human Services, and several federal courts, make it clear genderaffirming procedures that are medically necessary are not cosmetic.
148. Ms. Lane’s requested procedure was deemed medically
necessary by multiple medical professionals who are qualified to make
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such determinations. Thus, the procedure should not be denied under the
State Plan’s exclusion for “Cosmetic Surgeries/Services.”
149. The purpose of changing sex characteristics is to treat gender
dysphoria. This purpose underscores the medical necessity as opposed
to cosmetic nature of these treatments. Facial feminization surgery is not
designed to “improve the appearance” of a person’s face, but rather to
affirm a transgender woman’s gender identity in that the face functions as
a face that is consistent with the person’s gender identity. Accordingly,
facial feminization is a form of sex reassignment surgery.
150. Peer-reviewed

medical

literature,

medical

opinions

of

professional societies, evidence-based professional standards of care,
and the opinions of health care professionals involved in the specialty of
treating gender dysphoria concur that facial feminization surgery is safe,
effective, and medically necessary for treating gender dysphoria.
Exhaustion of Administrative Remedies
151. On June 4, 2019, Ms. Lane timely filed a charge with the Equal
Employment Opportunity Commission (“EEOC”) against Capital Health
Plan and the Florida Department of Management Services for sex
discrimination in violation of Title VII.

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152. On July 18, 2019, the EEOC issued a Dismissal and Notice of
Right to Sue for the charge against Capital Health.
153. On July 22, 2019, Ms. Lane requested the Notice of Right to Sue
for the charge against the Florida Department of Management Services.
154. On August 1, 2019, the EEOC notified Ms. Lane that the request
for the Notice of Right to Sue for the charge against the Florida
Department of Management Services had been forwarded to the U.S.
Department of Justice for action.
155. On November 4, 2019, Ms. Lane received the Notice of Right to
Sue letter from the U.S. Department of Justice for the charge against the
Florida Department of Management Services.
156. On October 18, 2019, Ms. Lane timely filed a charge with the
EEOC against Andy Thomas in his official capacity as Public Defender of
the Second Judicial Circuit for sex discrimination in violation of Title VII.
157. On November 5, 2019, Ms. Lane requested the Notice of Right
to Sue for the charge against Andy Thomas in his official capacity as
Public Defender of the Second Judicial Circuit.
COMMON ALLEGATIONS FOR CLAIMS I, II AND III,
TITLE VII OF THE CIVIL RIGHTS ACT OF 1964
158. Plaintiffs incorporate by reference paragraphs 1 through 157 of
the Complaint as if fully set forth below.
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159. Title VII of the Civil Rights Act of 1964 provides that employers
may not “discriminate against any individual with respect to his
compensation, terms, conditions, or privileges of employment, because
of such individual’s ... sex.” 42 U.S.C. § 2000e-2(a)(1).
160. An employer-sponsored health plan constitutes “compensation,
terms, conditions, or privileges of employment.” 42 U.S.C. § 2000e2(a)(1).
161. Title VII’s prohibition on “sex” discrimination encompasses
discrimination based on failure to conform to gender stereotypes – i.e.,
failing to act and appear according to gender-expressive expectations
ordinarily assigned to men and women.
162. A person is defined as transgender precisely because of the
perception that they contradict the gender stereotypes associated with the
sex they were assigned at birth. The very expression that associates
some transgender people with being transgender itself contradicts
stereotypes of expected appearance and behavior for the sex they were
assigned at birth.
163. Discrimination against a transgender individual because of their
gender non-conformity is sex-based discrimination under Title VII,
whether described as being on the basis of sex or gender.
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164. When a transgender person affirms their authentic gender, it
inherently contradicts standard gender stereotypes expected of the
individual based on their sex assigned at birth. An individual who was
assigned male at birth contradicts gender stereotypes and engages in
gender non-conforming behavior when seeking to feminize their body.
165. Discrimination against transgender individuals seeking to align
their bodies to match their gender identities is sex-based discrimination.
166. Denying medically necessary coverage to an individual for
“gender reassignment or modification” surgery constitutes impermissible
discrimination based on gender non-conformity.
167. Discrimination against a transgender individual because of their
gender non-conformity or their gender transition is discrimination on the
basis of “sex” under Title VII.
168. Not all transgender state employees seek to conform their bodies
to match their gender identities. What helps one transgender employee
alleviate gender dysphoria might be very different from what helps
another, and what is medically necessary to address the employee’s
gender dysphoria is a decision made on an individualized basis. For
some transgender employees, however, medical treatment, including
surgical intervention, remains essential and medically necessary to
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alleviate gender dysphoria. Further, some transgender state employees
have already undergone treatment for gender-affirmation, and still others
choose not to proceed for individual reasons. However, the exclusion
need not injure all members of a protected class for it to constitute sex
discrimination.
169. All individuals, whether transgender or cisgender, have their own
understanding of their genders. A transgender person’s understanding of
their gender impacts the dysphoria they may experience when certain
physical characteristics do not align with their gender identity.
170. However, the only individuals who require medically necessary
care to treat gender dysphoria, and thus the only individuals to whom the
State Plan Exclusion is being applied, are transgender individuals. As a
result of the State Plan Exclusion, non-transgender employees receive
coverage for all medically necessary healthcare, but transgender
employees do not.
171. The State Plan Exclusion implicates sex stereotyping by limiting
the ability of a transgender person to transition, if not rendering it
economically infeasible, thus requiring transgender individuals to
maintain the physical characteristics of their birth-assigned sex. The State
Plan Exclusion illegally discriminates against transgender persons by
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mandating that transgender individuals preserve the physical attributes of
their birth-assigned sex over specific medical recommendations to the
contrary.
172. The State Plan Exclusion on its face treats transgender
individuals differently on the basis of sex, thus triggering the protections
of Title VII.
CLAIM I
VIOLATION OF TITLE VII OF THE CIVIL RIGHTS ACT OF 1964
All Plaintiffs against Florida Department of Management Services
173. Plaintiffs incorporate by reference paragraphs 1 through 172 of
the Complaint as if fully set forth below.
174. Defendant Department has more than fifteen employees and is
an “employer” as that term is defined in Title VII, 42 U.S.C. § 2000e(b).
175. Plaintiffs are “employees” of the State of Florida, as that term is
defined in Title VII, 42 U.S.C. § 2000e(f).
176. Defendant Department substantially controls the terms and
conditions of employment for employees in the State of Florida, including
by establishing the scope of insurance coverage and administering that
coverage for all state employees.

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177. The State Plans, solicited and implemented by the Department,
provided to Plaintiffs by the State agencies employing them, and
administered by AvMed and Capital Health, facially discriminate based on
Plaintiffs’ gender non-conformity and gender-affirmation by categorically
excluding coverage for all medically necessary “gender reassignment or
modification services or supplies.”
178. By providing facially discriminatory State Plans that categorically
exclude all healthcare related to “gender reassignment or modification”
from the only available health plan it provides to employees, Defendant
Department

has

unlawfully

discriminated

against

Plaintiffs—and

continues to unlawfully discriminate against them—“with respect to
compensation, terms, conditions, or privileges of employment, because
of…sex.” 42 U.S.C. 2000e-2(a)(1).
CLAIM II
VIOLATION OF TITLE VII OF THE CIVIL RIGHTS ACT OF 1964
Plaintiff Claire against Defendant University of Florida
Board of Trustees
179. Plaintiff incorporates by reference paragraphs 1 through 113 and
158 through 172 of the Complaint as if fully set forth below.
180. Defendant Board of Trustees has more than fifteen employees
and is an employer within the meaning of Title VII, 42 U.S.C. § 2000e(b).
42

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181. Ms. Claire is an employee of the University of Florida Board of
Trustees as that term is defined in Title VII, 42 U.S.C. § 2000e(f).
182. The State Plan provided to Ms. Claire through her employment
facially discriminates based on Plaintiff’s gender non-conformity and
gender transition by categorically excluding coverage for all medically
necessary “gender reassignment or modification services or supplies.”
183. Defendant Board of Trustees offers additional health care plan
options to other university employees through Gator Care, a private Direct
Service Organization.
184. By law, Defendant Board of Trustees must provide employee
compensation and benefits, including health-insurance coverage, in a
non-discriminatory manner. It has chosen to provide gender-affirming
care to some, but not all, of its employees. This is a deliberate policy
decision by the Board of Trustees that discriminates against those
employees who are transgender, like Ms. Claire, and who are only offered
the State Plans with the State Plan Exclusion.
185. By providing facially discriminatory State Plans that exclude all
healthcare related to “gender reassignment or modification” from the only
available health plans it provides to employees such as Plaintiff Claire,
Defendant Board of Trustees has unlawfully discriminated against Ms.
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Claire—and continues to unlawfully discriminate against her—“with
respect to compensation, terms, conditions, or privileges of employment,
because of…sex.” 42 U.S.C. 2000e-2(a)(1).
CLAIM III
VIOLATION OF TITLE VII OF THE CIVIL RIGHTS ACT OF 1964
Plaintiff Lane against Defendant Thomas
186. Plaintiff incorporates by reference paragraphs 1 through 59 and
114 through 172 of the Complaint as if fully set forth below.
187. Defendant Thomas in his official capacity as Public Defender of
the Second Judicial Circuit of Florida has more than fifteen employees
and is an employer as that term is defined in Title VII, 42 U.S.C. § 2000e(b).
188. Ms. Lane is an employee of the Public Defenders Office of the
Second Judicial Circuit as that term is defined in Title VII, 42 U.S.C. §
2000e(f).
189. The State Plan provided to Ms. Lane through her employment
facially discriminates based on Plaintiff’s gender non-conformity and
gender transition by categorically excluding coverage for all medically
necessary “gender reassignment or modification services or supplies.”

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190. By providing facially discriminatory State Plans that exclude all
healthcare related to “gender reassignment or modification” from the only
available health plans provided to employees such as Plaintiff Lane,
Defendant Thomas has unlawfully discriminated against Ms. Lane—and
continues to unlawfully discriminate against her—“with respect to
compensation, terms, conditions, or privileges of employment, because
of…sex.” 42 U.S.C. 2000e-2(a)(1).
COMMON ALLEGATIONS FOR CLAIMS IV, V, AND VI,
EQUAL PROTECTION CLAUSE
191. Plaintiffs incorporate by reference paragraphs 1 through 157 of
the Complaint as if fully set forth below.
192. The Equal Protection Clause of the Fourteenth Amendment to
the United States Constitution prohibits the states and state actors from
discriminating against individuals on the basis of sex.
193. Discrimination on the basis of gender stereotype is sex-based
discrimination.
194. Discrimination against someone because of their gender nonconformity is sex-based discrimination.
195. A person is defined as transgender precisely because of the
perception that they contradict the gender stereotypes associated with the
sex they were assigned at birth. The very expression that associates
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some transgender people with being transgender itself contradicts
stereotypes of expected appearance and behavior for the sex they were
assigned at birth.
196. Discrimination against a transgender individual because of their
gender non-conformity is sex discrimination under the Equal Protection
Clause, whether it is described as being on the basis of sex or gender.
197. When a transgender person affirms their authentic gender, it
inherently contradicts standard gender stereotypes expected of the
individual based on their sex assigned at birth. An individual who was
assigned male at birth contradicts gender stereotypes and engages in
gender non-conforming behavior when seeking to feminize their body.
198. Discrimination against transgender individuals seeking to align
their bodies to match their gender identities is sex-based discrimination.
199. Denying medically necessary coverage to an individual for
“gender reassignment or modification” surgery constitutes impermissible
discrimination based on gender non-conformity.
200. The Equal Protection Clause of the Fourteenth Amendment to
the United States Constitution prohibits the states and state actors from
discriminating against transgender individuals based on their gender
identity and gender non-conformity.
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201. The Equal Protection Clause of the Fourteenth Amendment to
the United States Constitution prohibits the states and state actors from
discriminating against individuals because they are transgender.
202. The State Plan Exclusion, on its face and as applied to Plaintiffs,
impermissibly discriminates against Plaintiffs on the basis of their sex,
their gender non-conformity, and because they are transgender, and
violates their rights to equal protection of the laws.
203. Defendants’ actions purposefully single out a minority group,
transgender

persons,

that

historically

have

been

subjected

to

discriminatory treatment and are relegated to a position of political
powerlessness solely on the basis of stereotypes and myths regarding
their gender identity —a characteristic that bears no relation to their ability
to contribute to society and is immutable.
204. The Equal Protection Clause requires the government to confer
to all women – cisgender and transgender – full citizen stature, which
includes equal opportunity to aspire, participate in, and contribute to
society based on their individual talents and capacities. When the State
employs people, full citizenship stature means providing equal benefits
for the contributions they make as State employees.

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205. Discrimination on the basis of sex is a quasi-suspect class and
is subject to heightened scrutiny.
206. Discrimination against individuals on the basis of their being
transgender is independently subject to heightened scrutiny.
207. The State Plan Exclusion is not narrowly tailored to serve a
compelling governmental interest.
208. The State Plan Exclusion is not substantially related to an
important governmental interest.
209. The only function of the State Plan Exclusion is to exclude
medical care that would otherwise qualify as medically necessary under
the State Plan’s generally applicable standards.
210. The State Plan Exclusion is grounded in sex stereotypes and
discomfort with Plaintiffs’ gender transition and gender non-conformity.
CLAIM IV
EQUAL PROTECTION CLAUSE
All Plaintiffs against Defendant Satter
211. Plaintiffs incorporate by reference paragraphs 1 through 157 and
191 through 210 of the Complaint as if fully set forth below.
212. The State Plan Exclusion, on its face and as applied to Plaintiffs,
impermissibly discriminates against Plaintiffs on the basis of sex and
gender non-conformity and their being transgender and violates their right
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to Equal Protection of the laws under the Fourteenth Amendment to the
United States Constitution
213. As a direct and proximate result of the discrimination described
above, Plaintiffs have suffered injury and damages, including mental pain
and suffering and emotional distress. Without injunctive relief from
Defendants’ discriminatory exclusion of coverage for gender-affirming
care, Plaintiffs will continue to suffer irreparable harm in the future.
CLAIM V
EQUAL PROTECTION CLAUSE
Plaintiff Claire against Defendants Hosseini, Kuntz, Brandon,
Heavener, Johnson, Murphy, O’Keefe, Patel, Powers, Rosenberg,
Stern, Thomas, and Zucker, in their official capacities as members of
the University of Florida Board of Trustees
214. Plaintiff incorporates by reference paragraphs 1 through 113 and
191 through 210 of the Complaint as if fully set forth below.
215. Defendants have the duty and legal authority to provide
compensation and benefits, including health-insurance coverage, in a
non-discriminatory manner. They have chosen to provide genderaffirming care to some, but not all, of their employees. This is a deliberate
policy decision by the Board of Trustees that discriminates against those
employees who are transgender, like Ms. Claire, and who are only offered
the State Plans with the State Plan Exclusion.
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216. The State Plan Exclusion, on its face and as applied to Ms.
Claire, impermissibly discriminates against her on the basis of sex and
gender non-conformity and her being transgender and violates her right
to equal protection of the laws under the Fourteenth Amendment to the
United States Constitution.
217. As a direct and proximate result of the discrimination described
above, Ms. Claire has suffered injury and damages, including mental pain
and suffering and emotional distress. Without injunctive relief from
Defendants’ discriminatory exclusion of coverage for gender-affirming
care, Ms. Claire will continue to suffer irreparable harm in the future.
CLAIM VI
EQUAL PROTECTION CLAUSE
Plaintiff Lane against Defendant Thomas
218. Plaintiff incorporates by reference paragraphs 1 through 59, 114
through 157, and 191 through 210 of the Complaint as if fully set forth
below.
219. The State Plan Exclusion, on its face and as applied to Ms. Lane,
impermissibly discriminates against her on the basis of sex and gender
non-conformity and her being transgender and violates her right to Equal
Protection of the laws under the Fourteenth Amendment to the United
States Constitution.
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220. As a direct and proximate result of the discrimination described
above, Ms. Lane has suffered injury and damages, including mental pain
and suffering and emotional distress. Without injunctive relief from
Defendants’ discriminatory exclusion of coverage for gender-affirming
care, Ms. Lane will continue to suffer irreparable harm in the future.
RELIEF REQUESTED
WHEREFORE, Plaintiffs respectfully request that this Court enter
judgment against the Defendants and award the following relief:
A. Declaratory relief, including, but not limited to, a declaration that
Defendants are in violation of the Equal Protection Clause of the
Fourteenth Amendment of the U.S. Constitution, and Title VII.
B. Permanent injunctive relief with respect to all Defendants, requiring

Defendants to: (1) cease enforcement of the State Plan Exclusion
of coverage for “gender reassignment or modification services or
supplies,” and (2) provide benefits that cover Plaintiffs’ medically
necessary gender-affirming care.
C. Permanent injunctive relief with respect to Defendant Florida
Department of Management Services to prohibit the Department
from soliciting and accepting bids, and granting contracts, for health

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insurance plans that contain an exclusion of coverage for genderaffirming care.
D. Award Plaintiffs with respect to all Defendants compensatory
damages, including emotional distress, and other appropriate relief
as permitted by law.
E. Award reasonable attorneys’ fees and costs where allowed by law.
F. Award all other relief to which Plaintiffs may be entitled that the
Court deems just and equitable.
Dated: January 13, 2020

Respectfully submitted,
/s/ Simone Chriss
SIMONE CHRISS, Fla. Bar No. 124062
simone.chriss@southernlegal.org
KIRSTEN ANDERSON, Fla. Bar No. 17179
kirsten.anderson@southernlegal.org
JODI SIEGEL, Fla. Bar No. 511617
jodi.siegel@southernlegal.org
Southern Legal Counsel, Inc.
1229 NW 12th Avenue
Gainesville, FL 32601
(352) 271-8890
DANIEL TILLEY, Fla. Bar No. 102882
dtilley@aclufl.org
ACLU Foundation of Florida
4343 West Flagler St., Suite 400,
Miami, FL 33134
(786) 363-2714
ANTON MARINO, D.C. Bar No. 1028871
Fla. Bar pending; will submit pro hac vice
52

 Case 4:20-cv-00020-MW-CAS Document 1 Filed 01/13/20 Page 53 of 53

amarino@aclufl.org
ACLU Foundation of Florida
4343 West Flagler St., Suite 400
Miami, FL 33134
(786) 363-2707
JIMMY MIDYETTE, Fla. Bar No. 495859
jmidyette@aclufl.org
ACLU Foundation of Florida
118 W Adams St., Suite 510
Jacksonville, FL 32202
(904) 228-4797
ERIC LINDSTROM, Fla. Bar No. 104778
elindstrom@eganlev.com
Egan, Lev, Lindstrom & Siwica, P.A.
P.O. Box 5276
Gainesville, FL 32627
(352) 672-6901
ATTORNEYS FOR PLAINTIFFS

53